# Need a php form by Saturday

**URL:** <https://forum.kirupa.com/t/need-a-php-form-by-saturday/200006>\
**Category:** jobs\
**Created:** [September 7, 2006, 10:52pm UTC](https://forum.kirupa.com/t/need-a-php-form-by-saturday/200006 "2006-09-07T22:52:08Z")\
**Posts on this page:** 1\
**Page:** 1

<div class="post-metadata">

**Author:** ![rusty27851](https://avatars.discourse-cdn.com/v4/letter/r/edb3f5/32.png) [@rusty27851](https://forum.kirupa.com/u/rusty27851)\
**Post date:** [September 7, 2006, 10:52pm UTC](https://forum.kirupa.com/t/need-a-php-form-by-saturday/200006/1 "2006-09-07T22:52:08Z")

</div>

I need php form within the next 2 days and thought I’d check to see if you anyone was interested. Here is the information on the form:

It should include the following fields:

Name  
Address (optional) (and include city, state, and zip code)  
Email  
Quantity of dvds (drop-down list for quantity - options 1, 2, 3, 4, 5).

Name and email should be required fields. The results of the form should be sent to my address and a confirmation email needs to be sent to the person filling out the form. The form should be safe and not hackable or exploitable. I will add all the graphics, all I need you to do is the coding of the form. I’m looking to spend no more than $50 on the form. I need the form by tomorrow or Saturday at the latest.  
Thanks,

Rusty